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To determine whether colonization with extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients.
Prospective cohort study.
The 2 ICUs in the University Hospital Basel in Switzerland.
All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours.
Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of carbapenem exposure were compared using the Mann-Whitney U test.
Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40–271.41; P = .007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01–5.79; P = .047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3–8 days] vs median, 6 days [IQR 3–9 days]; P = 0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44–2.30; P = .993) or death attributable to infection (HR, 1.20; 95% CI, 0.28–5.11; P = .808).
Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.
Worldwide, Mycobacterium chimaera infections have been linked to contaminated aerosols from heater-cooler units (HCUs) during open-heart surgery. These infections have mainly been associated with the 3T HCU (LivaNova, formerly Sorin). The reasons for this and the risk of transmission from other HCUs have not been systematically assessed.
Prospective observational study.
University Hospital Basel, Switzerland.
Continuous microbiological surveillance of 3 types of HCUs in use (3T from LivaNova/Sorin and HCU30 and HCU40 from Maquet) was initiated in June 2014, coupled with an epidemiologic workup. Monthly water and air samples were taken. Construction design was analyzed, and exhausted airflow was measured.
Mycobacterium chimaera grew in 8 of 12 water samples (66%) and 22 of 24 air samples (91%) of initial 3T HCUs in use, and in 2 of 83 water samples (2%) and 0 of 41 (0%) air samples of new replacement 3T HCUs. Moreover, 7 of 12 water samples (58%) and 0 of 4 (0%) air samples from the HCU30 were positive, and 0 of 64 (0%) water samples and 0 of 50 (0%) air samples from the HCU40 were positive. We identified 4 relevant differences in HCU design compared to the 3T: air flow direction, location of cooling ventilators, continuous cooling of the water tank at 4°C, and an electronic alarm in the HCU40 reminding the user of the next disinfection cycle.
All infected patients were associated with a 3T HCU. The individual HCU design may explain the different risk of disseminating M. chimaera into the air of the operating room. These observations can help the construction of improved devices to ensure patient safety during cardiac surgery.
To evaluate host characteristics, mode of infection acquisition, and infection control procedures in patients with a positive respiratory syncytial virus (RSV) test result after the introduction of the GenXpert Influenza/RSV polymerase chain reaction (PCR) assay.
Retrospective cohort study.
Adults with a positive PCR test result for RSV who were hospitalized in a tertiary academic medical center between January 2015 and December 2016 were included in this study. Our infection control policy applies contact isolation precautions only for immunocompromised patients.
Patients were identified through 2 databases, 1 consisting of patients isolated because of RSV infection and 1 with automatically collected laboratory results. Baseline and clinical characteristics were collected through a retrospective medical chart review. The rate of and clinical factors associated with healthcare-associated RSV infections were evaluated.
In total, 108 episodes in 106 patients hospitalized with a positive Xpert RSV test result were recorded during the study period. Among them, 11 episodes were healthcare-associated infections (HAIs) and 97 were community-acquired infections (CAIs). The mean length of hospital stay (LOS, 40.2 vs 11.2 days), the mean number of room switches (3.5 vs 1.7) and ward switches (1.5 vs 0.4), and the mean numbers of contact patients (9.9 vs 3.8) were significantly longer and higher in the HAI group than in the CAI group (P<.0001). Surveillance of microbiology records and clinical data did not reveal evidence for a cluster or an epidemic during the 2-year observation period.
The introduction of a rapid molecular diagnostic test systematically applied to patients with influenza-like illness may challenge current infection control policies. In our study, patients with HAIs had a prolonged hospital stay and a high number of contact patients, and they switched rooms and wards frequently.
Infect Control Hosp Epidemiol 2017;38:1291–1297
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